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    <div id="content">
        <h1>
            Pyrexia of unknown origin</h1>
        <h5 class="updated">
            Last updated: Friday, 28, January, 2011</h5>
        <table cellpadding="0" cellspacing="0" class="two-column-process">
            <thead>
                <tr>
                    <th>
                        Causes</th>
                    <th class="description">
                        Appropriate Tests</th>
                </tr>
            </thead>
            <tr class="odd">
                <td class="first">
                    <p>
                        PUO is defined as undiagnosed fever of more than 3 weeks duration.</p>
                </td>
                <td class="second">
                    <p>
                        Careful and repeated clinical history and examination; <b>FBC, blood film, 
                        differential WCC; CRP ; bilirubin, ALP, AST, ALT, GGT, LD</b>.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Bacterial infection, especially
                    </p>
                </td>
                <td class="second">
                    <b>Blood culture (repeated); urine microscopy and culture; faeces - microscopy, 
                    culture and antigen detection. </b>
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=208&amp;Itemid=27" 
                            target="_blank">Endocarditis</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=34&amp;Itemid=27" 
                            target="_blank">Abscess</a>, especially</p>
                    <ul>
                        <li>Intra-abdominal</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Ascending cholangitis
                    </p>
                </td>
                <td class="second">
                    See
                    <a href="http://www.rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=124&amp;Itemid=27" 
                        target="_blank">Cholestasis</a></td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=566&amp;Itemid=27" 
                            target="_blank">Urinary tract infection</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=488&amp;Itemid=27" 
                            target="_blank">Osteomyelitis</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Typhoid fever</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=764&amp;Itemid=27" 
                            target="_blank">Tuberculosis</a></p>
                </td>
                <td class="second">
                    <b>Urine for mycobacteria testing</b>; collect early morning specimens (three).</td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=95&amp;Itemid=27" 
                            target="_blank">Brucellosis</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <b>Fungal infection</b></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=167&amp;Itemid=27" 
                            target="_blank">Cryptococcal infection</a></p>
                </td>
                <td class="second">
                    <b>Cryptococcal antigen - blood, CSF</b>, if appropriate.</td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <b>Protozoal infection</b></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=425&amp;Itemid=27" 
                            target="_blank">Malaria</a>&nbsp;</p>
                </td>
                <td class="second">
                    <b>Malaria parasites - blood - repeated thin and thick blood films</b>, if 
                    indicated.</td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=552&amp;Itemid=27" 
                            target="_blank">Toxoplasmosis</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <b>Viral infection </b>
                    </p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=175&amp;Itemid=27" 
                            target="_blank">Cytomegalovirus infection</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=322&amp;Itemid=27" 
                            target="_blank">HIV infection</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <b>Drug fever</b></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <b>Malignancy, especially</b></p>
                </td>
                <td class="second">
                    <b>FNAB, lesion biopsy</b>; as appropriate. Tumour markers are unreliable as a 
                    screening test for occult malignancy.</td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Renal cell carcinoma</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Hepatocellular carcinoma</p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Disseminated carcinoma
                    </p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=323&amp;Itemid=27" 
                            target="_blank">Hodgkin&#39;s disease</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=419&amp;Itemid=27" 
                            target="_blank">Lymphoma (non-Hodgkin&#39;s)</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Atrial myxoma
                    </p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <b>Other</b></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=153&amp;Itemid=27" 
                            target="_blank">Connective tissue diseases</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=575&amp;Itemid=27" 
                            target="_blank">Vasculitis</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Granulomatous hepatitis</p>
                </td>
                <td class="second">
                    See
                    <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=305&amp;Itemid=27" 
                        target="_blank">Hepatitis</a> - Granulomatous</td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=687&amp;Itemid=27" 
                            target="_blank">Sarcoidosis</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        <a href="http://rcpamanual.edu.au/index.php?option=com_clinical&amp;task=show_clinical&amp;id=163&amp;Itemid=27" 
                            target="_blank">Crohn&#39;s disease</a></p>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd">
                <td class="first">
                    <p>
                        Familial Mediterranean fever</p>
                </td>
                <td class="second">
                    <p>
                        Clinical diagnosis.</p>
                    <p>
                        <b>CRP</b> (intermittent elevation); <b>biopsy</b> of appropriate tissue only if 
                        clinical features suggest amyloidosis.</p>
                </td>
            </tr>
            <tr>
                <td class="first">
                    <p>
                        Occult haematoma, especially</p>
                    <ul>
                        <li>Retroperitoneal haematoma</li>
                    </ul>
                </td>
                <td class="second">
                </td>
            </tr>
            <tr class="odd-last">
                <td class="first">
                    <p>
                        Factitious fever
                    </p>
                </td>
                <td class="second">
                </td>
            </tr>
        </table>
    </div>
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            <h2>
                Glossary Terms</h2>
            <div>
                <h4>
                    ALT :</h4>
                <p>
                    Alanine aminotransferase</p>
                <h4>
                    ALP :</h4>
                <p>
                    Alkaline phosphatase</p>
                <h4>
                    AST :</h4>
                <p>
                    Aspartate aminotransferase</p>
                <h4>
                    CRP :</h4>
                <p>
                    C-reactive protein</p>
                <h4>
                    FBC :</h4>
                <p>
                    Full blood count , full blood examination, complete blood count</p>
                <h4>
                    FNAB :</h4>
                <p>
                    Fine needle aspiration biopsy</p>
                <h4>
                    GGT :</h4>
                <p>
                    Gamma glutamyl transferase (transpeptidase)</p>
                <h4>
                    HIV :</h4>
                <p>
                    Human&nbsp;immunodeficiency&nbsp;virus</p>
                <h4>
                    PUO :</h4>
                <p>
                    Pyrexia of unknown origin</p>
                <h4>
                    WCC :</h4>
                <p>
                    white cell count, leucocyte count</p>
            </div>
        </div>
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